Discussion
Language barriers in healthcare are apparent and their negative
consequences are widely recognized. This scoping review is the first to
provide a qualitative synthesis of the literature on the potential of
medical students in bridging the language barrier in academic healthcare
centers by engaging as interpreters.
In the context where access to medical interpretation services is often
limited, students constitute a favorable alternative to other forms of
ad hoc interpretation such as family and friends. Multilingual medical
students are often asked to interpret in patient encounters and
represent a valuable resource towards providing language-concordant
care. 20,24,33,34 Positive attitudes have been
expressed surrounding this practice, especially in situations where
students previously received interpretation training. Patients and
providers have reported being grateful for student involvement,
appreciating the additional availability for interpretation and rating
their performance highly. 32, 35 Students emphasized a
positive educational value in receiving such training, noting
improvement in communication skills, empathy, and cultural awareness.
They also acknowledged their value as team members and developed their
professional identity as patient advocates. 20, 35, 40Such training programs were also recognized to offload the demand for
interpretation among health systems. 20, 40
However, most medical students receive no formal education regarding
interpretation. Academic healthcare institutions and medical
schools can optimize the potential of students as interpreters in the
clinical setting by offering additional training. As existing programs
have shown, students would benefit from a blend of interpretation theory
and scenario-based activities. Post-training evaluation of students
should include direct observation of a clinical encounter, ideally
completed by a professional interpreter. The program format should be
condensed to accommodate the workload and time constraints of medical
students. Proposed funding models mainly consist of joined support from
a medical school and one of its affiliated health centres.
Challenges raised surrounding this practice relate predominantly to
ethical considerations. Students may be unaware of the professional
implications of an interpreter, thus limiting the distinction with their
role as a clinical learner. 14 In addition, variation
among students in fluency and knowledge of medical terminology in the
concerned language may result in differences in interpretation quality.
Measures have been taken to recognize and address these concerns.
Existing training programs are provided by professional interpreters and
cover the ethical-legal obligations of students in that role. Language
fluency is assessed in the evaluation process and students reported
increased confidence when asked to interpret following participation in
a program. 20, 35, 40
Additional guidelines should be established to standardize the
operationalization of student interpreters. There is currently a lack of
clear policies surrounding this practice, which may be a reflection of
the dearth of literature available to inform standards. Although some
countries have established recommendations around medical interpreters,
there is significant inconsistency across regulatory bodies and students
are often not mentioned explicitly. In the United States, the Affordable
Care Act requires all healthcare providers receiving federal assistance
to provide LLP patients with a qualified interpreter, including on-site
or video interpretation. 41 To be qualified, an
individual must complete a formal training program. In Canada,
healthcare interpretation services are seen as ancillary services that
are not universally ensured. However, there has been discussion on
whether these services should be considered medically necessary.
It is also important to recognize that formal interpreters remain the
gold standard in providing language-concordant care, and efforts should
be made to improve access to these services.